Tooth decay doesn’t suddenly appear out of the blue. Cavities and other damage are the result of a long process that begins with bacteria living in a thin biofilm on tooth surfaces known as plaque. These bacteria thrive on sugars from leftover food in your mouth and then produce acid as a waste product. Chronic high levels of acid cause your enamel, the protective layer of your teeth, to soften and erode.

While there are treatment options at each stage of decay — including crowning or even tooth replacement — the best approach is to try to prevent plaque buildup that supports disease-causing bacteria. Here are 3 of the best ways you can do that.

Brush and floss daily. It usually takes 12-24 hours for enough plaque buildup to support bacteria. By brushing and flossing at least once a day, you can remove most of this buildup, with twice a year dental cleanings to remove hard to reach plaque you may have missed. Be sure to use fluoride toothpaste to help strengthen enamel against high acid. And wait a half hour to an hour after eating before brushing to give saliva time to reduce the acid level in your mouth.

Cut back on sweets. You’re not the only one who loves sugary snack foods — so do oral bacteria. The more sugar and other carbohydrates they feast on, the more they produce acid. The best approach is to cut out sugar-rich snacks altogether and instead snack on fresh fruits, raw vegetables or dairy products. Limit sweet treats to meal times.

Use decay-fighting supplements. Your mouth and hygiene efforts may need a little assistance, especially if you have low saliva flow. You can boost this with an artificial saliva supplement as well as with products containing xylitol, an alcohol-based sugar. Xylitol also has an added benefit in the fight against decay because it inhibits bacterial growth. And be sure to talk with us first before taking any dental supplement.

]]>Sun, 19 May 2019 00:04:57 -0700Your Teenager not Ready for an Implant? Here's What We Can Do Insteadhttp://www.cowetadentistry.com/blog/post/your-teenager-not-ready-for-an-implant-heres-what-we-can-do-instead.html

Losing a tooth can be traumatic, but a dental implant can dramatically turn that experience around. Providing functionality, life-like appearance and durability, implants stand out as the premier restoration for lost teeth.

For adults, that is. An older child or teenager with a missing tooth may need to wait a few more years for an implant. The reason: jaw development. A person's jaws, particular the upper jaw, continue to grow with most growth completed by early adulthood. Natural teeth with their periodontal attachments develop right alongside the jaw.

But because an implant attaches directly to the jawbone, its position is fixed: it won't change as the jaw grows and may gradually appear to sink below the gum line. That's why we wait to place an implant until most of jaw maturity has occurred after full jaw maturity. For females, we try to wait until 20 years of age and for males, usually 21 years of age. These are guidelines as some people mature faster and some slower, so a discussion with your dentist or surgeon is necessary to make an educated decision.

While we wait, we can install a temporary replacement for a child's or teenager's lost tooth, usually a partial denture or fixed modified ("Maryland") bridge. The latter affixes a prosthetic (false) tooth in the missing tooth space by attaching it to the back of natural teeth on either side with bonded dental material. It differs from a traditional bridge in that these supporting teeth aren't permanently altered and crowned to support the bridge.

During the time before implants we should understand that the area where the implant will be placed will undergo some bone deterioration, a common consequence of missing teeth. Forces generated as we chew travel through the teeth to stimulate renewing bone growth all along the jawbone. But with a lost tooth the chewing stimulation ceases at that part of the bone, slowing the growth rate and leading to gradual bone loss.

Fortunately, the titanium posts of dental implants stimulate bone growth as bone cells naturally grow and adhere to their surfaces. Before then, though, if the bone volume is diminished, we may need to graft bone material to stimulate bone growth that will enlarge the jaw bone enough for an implant to be placed.

It usually isn't a question of "if" but "when" we can provide your child with an implant for their missing tooth. In the meantime, we can prepare for that day with a temporary restoration.

]]>Thu, 09 May 2019 00:04:21 -0700New Front Teeth for a Teenaged David Duchovnyhttp://www.cowetadentistry.com/blog/post/new-front-teeth-for-a-teenaged-david-duchovny.html

In real life he was a hard-charging basketball player through high school and college. In TV and the movies, he has gone head-to-head with serial killers, assorted bad guys… even mysterious paranormal forces. So would you believe that David Duchovny, who played Agent Fox Mulder in The X-Files and starred in countless other large and small-screen productions, lost his front teeth… in an elevator accident?

“I was running for the elevator at my high school when the door shut on my arm,” he explained. “The next thing I knew, I was waking up in the hospital. I had fainted, fallen on my face, and knocked out my two front teeth.” Looking at Duchovny now, you’d never know his front teeth weren’t natural. But that’s not “movie magic” — it’s the art and science of modern dentistry.

How do dentists go about replacing lost teeth with natural-looking prosthetics? Today, there are two widely used tooth replacement procedures: dental implants and bridgework. When a natural tooth can’t be saved — due to advanced decay, periodontal disease, or an accident like Duchovny’s — these methods offer good looking, fully functional replacements. So what’s the difference between the two? Essentially, it’s a matter of how the replacement teeth are supported.

With state-of-the-art dental implants, support for the replacement tooth (or teeth) comes from small titanium inserts, which are implanted directly into the bone of the jaw. In time these become fused with the bone itself, providing a solid anchorage. What’s more, they actually help prevent the bone loss that naturally occurs after tooth loss. The crowns — lifelike replacements for the visible part of the tooth — are securely attached to the implants via special connectors called abutments.

In traditional bridgework, the existing natural teeth on either side of a gap are used to support the replacement crowns that “bridge” the gap. Here’s how it works: A one-piece unit is custom-fabricated, consisting of prosthetic crowns to replace missing teeth, plus caps to cover the adjacent (abutment) teeth on each side. Those abutment teeth must be shaped so the caps can fit over them; this is done by carefully removing some of the outer tooth material. Then the whole bridge unit is securely cemented in place.

While both systems have been used successfully for decades, bridgework is now being gradually supplanted by implants. That’s because dental implants don’t have any negative impact on nearby healthy teeth, while bridgework requires that abutment teeth be shaped for crowns, and puts additional stresses on them. Dental implants also generally last far longer than bridges — the rest of your life, if given proper care. However, they are initially more expensive (though they may prove more economical in the long run), and not everyone is a candidate for the minor surgery they require.

The most important part of dental health maintenance isn’t what your dentist does—it’s what you do every day when you brush and floss your teeth. And all you really need is a multi-tufted, soft bristle toothbrush, toothpaste, a roll of dental floss—plus a little effort from your hands and fingers.

Of course, manual power isn’t your only option—an electric or battery-powered toothbrush is a convenient and, for people with strength or dexterity issues, a necessary way to remove disease-causing plaque from tooth surfaces. You have a similar option with flossing—a water flosser.

Although water flossers (or oral irrigators) have been around since the early 1960s, they’ve become more efficient and less expensive in recent years. A water flosser delivers a pulsating stream of pressurized water between the teeth through a handheld device that resembles a power toothbrush, but with a special tip. The water action loosens plaque and then flushes it away.

While the convenience these devices provide over traditional flossing is a major selling point, they’re also quite beneficial for people with special challenges keeping plaque from accumulating between teeth. People wearing braces or other orthodontic devices, for example, may find it much more difficult to effectively maneuver thread floss around their hardware. Water flossing can be an effective alternative.

But is water flossing a good method for removing between-teeth plaque? If performed properly, yes. A 2008 study, for example, reviewed orthodontic patients who used water flossing compared to those only brushing. The study found that those using water flossing were able to remove five times as much plaque as the non-flossing group.

If you’re considering water flossing over traditional flossing thread, talk with your dental hygienist. He or she can give you advice on purchasing a water flosser, as well as how to use the device for optimum performance. It could be a great and more convenient way to keep plaque from between your teeth and harming your dental health.

You probably know practicing healthy dietary and lifestyle habits can help prevent tooth decay and periodontal (gum) disease. But good habits could also lower your risk for a more dangerous type of disease — oral cancer.

There are several risk factors for oral cancer, including those you can't do much about like your genetic makeup or unknown elements in the environment. But there are factors you can influence with your actions.

You're probably familiar with the links between tobacco use (both smoked and smokeless) and oral cancer. But excessive alcohol use could also increase your risk, as can risky sexual behavior that could expose you to human papilloma virus (HPV) 16.

And what you eat — or don't eat — could also influence your cancer risk. Research over the last half century has uncovered a link between diet and cancer. Cancer development seems to begin with damage to DNA, the genetic material that “tells” each of our cells what it is and what it does in the body. Substances called carcinogens found in the environment — including the foods we eat — can damage our DNA and open the door for cancer to development.

But some foods also contain elements that protect our DNA from carcinogenic damage. Some of these are known as antioxidants, which protect cells from unstable molecules called free radicals. You'll find antioxidants, as well as other protective substances like fiber, vitamins and lycopene in plant-based foods, particularly fruits and vegetables.

Eating a plant-based diet also means you'll eat fewer foods that contribute to the rise of free radicals like saturated fat, animal protein and nitrates (a chemical that occurs in some food processing). A healthy diet, along with quitting tobacco use and moderating alcohol consumption, will help not only preventing decay or gum disease, it will also drastically lower your risk for oral cancer.

In the sports world, athletes are always looking for an edge. And it’s not just college or professional sports—even Little Leaguers are focused on enhancing their performance.

That’s why sports and energy drinks have rocketed in popularity. With marketing pitches promising to increase stamina or replace lost nutrients from strenuous workouts, it’s not unusual to find these beverages in sports bags or the team water cooler.

But there’s a downside to them regarding your dental health—they’re often high in sugar and acidity. Both drink types could increase your risk of tooth decay or periodontal (gum) disease over time.

Sugar is a primary food source for the bacteria that can trigger a gum infection. They also produce acid, which at high levels can erode tooth enamel and lead to tooth decay. The risk for enamel erosion also increases with the drink’s acidity.

You can lessen your risk of these unpleasant outcomes by restricting your consumption of these beverages. In fact, unless your sports activity is highly strenuous for long periods, your best hydration choice is usually water.

But if you do drink a sports or energy drink for an extra lift, be sure to take these precautions for the sake of your teeth:

Try to drink them only at mealtimes. Continually sipping on these drinks between meals never gives your saliva a chance to neutralize mouth acid. Reserving acidic foods and beverages for mealtimes will allow saliva to catch up until the next meal.

Rinse with water after your drink. Water usually has a neutral pH. This can help dilute mouth acid and reduce the mouth’s overall acidity.

Don’t brush right after drinking or eating. Increased acid that can occur right after drinking or eating can immediately soften tooth enamel, but saliva can neutralize and help restore minerals to tooth enamel within an hour. Brushing during this period could remove tiny bits of the enamel’s minerals.

Taking these precautions will help keep sports or energy drinks from eroding your tooth enamel. Once it’s gone, you won’t be able to get it back.

If there's anything that makes Alfonso Ribeiro happier than his long-running gig as host of America's Funniest Home Videos, it's the time he gets to spend with his family: his wife Angela, their two young sons, and Alfonso's teenaged daughter. As the proud dad told Dear Doctor–Dentistry & Oral Health magazine, "The best part of being a father is the smiles and the warmth you get from your children."

Because Alfonso and Angela want to make sure those little smiles stay healthy, they are careful to keep on top of their kids' oral health at home—and with regular checkups at the dental office. If you, too, want to help your children get on the road to good oral health, here are five tips:

Start off Right—Even before teeth emerge, gently wipe baby's gums with a clean, moist washcloth. When the first teeth appear, brush them with a tiny dab of fluoride on a soft-bristled toothbrush. Schedule an age-one dental visit for a complete evaluation, and to help your child get accustomed to the dental office.

Teach Them Well—When they're first learning how to take care of their teeth, most kids need a lot of help. Be patient as you demonstrate the proper way to brush and floss…over and over again. When they're ready, let them try it themselves—but keep an eye on their progress, and offer help when it's needed.

Watch What They Eat & Drink—Consuming foods high in sugar or starch may give kids momentary satisfaction…but these substances also feed the harmful bacteria that cause tooth decay. The same goes for sodas, juices and acidic drinks—the major sources of sugar in many children's diets. If you allow sugary snacks, limit them to around mealtimes—that gives the mouth a chance to recover its natural balance.

Keep Up the Good Work—That means brushing twice a day and flossing at least once a day, every single day. If motivation is an issue, encourage your kids by letting them pick out a special brush, toothpaste or floss. You can also give stickers, or use a chart to show progress and provide a reward after a certain period of time. And don't forget to give them a good example to follow!

Get Regular Dental Checkups—This applies to both kids and adults, but it's especially important during the years when they are rapidly growing! Timely treatment with sealants, topical fluoride applications or fillings can often help keep a small problem from turning into a major headache.

Bringing your kids to the dental office early—and regularly—is the best way to set them up for a lifetime of good checkups…even if they're a little nervous at first. Speaking of his youngest child, Alfonso Ribeiro said "I think the first time he was really frightened, but then the dentist made him feel better—and so since then, going back, it's actually a nice experience." Our goal is to provide this experience for every patient.

]]>Wed, 20 Mar 2019 00:07:00 -0700Home Whitening Kits are Safe and Effective, if Used the Right Wayhttp://www.cowetadentistry.com/blog/post/home-whitening-kits-are-safe-and-effective-if-used-the-right-way.html

You’re satisfied with your smile appearance except for one thing — your teeth aren’t as white and bright as you wish they could be. So, you’ve decided to do something about their dull yellow color.

You’re also thinking about buying a whitening product you can use yourself rather than a professional application. But you still want the answers to two questions: are home whitening kits safe? And, are they effective?

By and large the answer to the first question is yes — if you use it as directed. The whitening agents in FDA-approved products are in safe proportions to other ingredients and won’t cause any major health issues. That said, if you go beyond the instructed dosage you could damage your teeth, especially your enamel, and cause long-term problems with your dental care.

In addition, if you (or a family member) are still in your early teens, you may want to wait until you’re older. Although most permanent teeth have come in by puberty, their enamel still needs to mature. The chemicals in a whitening kit could be too strong for their under-developed enamel. It’s best to get our advice on whether your teeth are mature enough for whitening.

As to their effectiveness, home whitening kits should perform as their labeling indicates. But there are some differences in effects between a home kit and a professional application.

Although a home kit usually uses the same whitening agents (like carbamide peroxide), its strength is much lower than a professional treatment — about 10% of volume compared to around 30% in clinical solutions. This means it will take much longer to achieve the desired whitening effect that a professional application can in fewer sessions, and with less precision. In addition, home kits are only effective on surface staining of the enamel — discoloration within a tooth requires treatment by a dentist.

You can get satisfactory results from a home whitening kit. But before you make a purchase, consult with us first — we can advise you on what to look for in your purchase, as well as determine if your teeth can benefit from whitening at home.

Proponents of legalized marijuana have won phenomenal gains over the last decade. Despite the federal government's continuing criminalization of the drug, several states including California, Colorado and Massachusetts, have voted to legalize its recreational use.

Most people are aware of the social and political controversies the marijuana legalization movement stirs. But there's another side to this roiling issue: the health effects of marijuana, particularly for your teeth and gums. What may be lost beneath the more exciting headlines about ballot initiatives is the growing evidence that habitual marijuana use may increase the risk and severity of periodontal (gum) disease.

Gum disease is a bacterial infection caused by dental plaque, a thin film of bacteria and food particles that accumulates on teeth. The spreading infection triggers inflammation, a normal bodily response to disease that's ordinarily beneficial. But if the inflammation becomes chronic it weakens the gums' attachment to the teeth. This can create voids or periodontal pockets of infection around the teeth. The disease can eventually damage the underlying bone, which could accelerate tooth loss.

Poor oral hygiene is the biggest factor for an increased risk of gum disease; thinner gum tissue (an inherited condition or related to poor tooth position) is another factor, as well as lifestyle habits like tobacco use or excessive alcohol consumption. Add marijuana to the list: there's now some evidence that its use increases the risk for more severe periodontal pockets if the disease occurs.

In a recent study, researchers with the Columbia University College of Dental Medicine reviewed statistics on the care for nearly 2,000 adult patients; a quarter of those in the study were frequent marijuana users. The marijuana users proportionately had deeper periodontal pocket occurrences than the rest of the patients in the study that didn't use the drug.

The study doesn't say that marijuana causes periodontal (gum) disease. But it does suggest that marijuana use might increase its severity. As with other substances and practices in our society, marijuana use comes with a caveat: it may be legal where you live, but it may not necessarily be good for your health.

Canker sores, known medically as aphthous ulcers, are fairly common among people. Lasting for about a week or so, these mouth sores are usually more irritating than painful. But about a quarter of the population, especially women, frequently suffer from an acute form that doesn't often respond well to over-the-counter remedies.

A typical canker sore is usually round with a yellow-gray center ringed by a reddened "halo." They can be preceded by tingling or painful sensations at the site a few hours or so before breaking out. Recurrent aphthous stomatitis (RAS) is the more severe form of canker sore, often with outbreaks of multiple painful sores. While the more common sore is usually less than a centimeter in diameter, RAS sores are often much larger.

Canker sores often arise during periods of stress or anxiety, and seem to be connected with eating certain acidic foods like tomato sauce, citrus fruits or spicy dishes. RAS also seems to be related to underlying systemic conditions like vitamin deficiencies, anemia or digestive disorders. Besides managing diet and stress, people with regular canker sores and milder cases of RAS can often find relief with non-prescription numbing agents often found in stores and pharmacies.

For more severe RAS, though, you may need the help of your dentist or physician with treatments like prescription steroids or other medications that come in gel or rinse form or through injections. The goal of any treatment approach is to decrease pain severity and shorten healing times after an outbreak.

While most mouth sores, including RAS, aren't dangerous to your health, you should still take any sore seriously. You should especially seek medical evaluation if a sore doesn't heal after a couple of weeks, if they seem to come more frequently and are more severe, or if you don't seem to ever be without a sore in your mouth. These could indicate a serious underlying problem that needs to be addressed.

One thing's for sure: there are ways to ease your suffering if you have frequent bouts with regular canker sores or even RAS. Talk to your dentist about ways to minimize your discomfort from these irritating mouth sores.

If you would like more information on aphthous ulcers or canker sores, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Mouth Sores.”

Sometimes it seems that appearances count for everything—especially in Hollywood. But just recently, Lonnie Chaviz, the 10-year-old actor who plays young Randall on the hit TV show This Is Us, delivered a powerful message about accepting differences in body image. And the whole issue was triggered by negative social media comments about his smile.

Lonnie has a noticeable diastema—that is, a gap between his two front teeth; this condition is commonly seen in children, but is less common in adults. There are plenty of celebrities who aren’t bothered by the excess space between their front teeth, such as Michael Strahan, Lauren Hutton and Vanessa Paradis. However, there are also many people who choose to close the gap for cosmetic or functional reasons.

Unfortunately, Lonnie had been on the receiving end of unkind comments about the appearance of his smile. But instead of getting angry, the young actor posted a thoughtful reply via Instagram video, in which he said: “I could get my gap fixed. Braces can fix this, but like, can you fix your heart, though?”

Lonnie is raising an important point: Making fun of how someone looks shows a terrible lack of compassion. Besides, each person’s smile is uniquely their own, and getting it “fixed” is a matter of personal choice. It’s true that in most circumstances, if the gap between the front teeth doesn’t shrink as you age and you decide you want to close it, orthodontic appliances like braces can do the job. Sometimes, a too-big gap can make it more difficult to eat and to pronounce some words. In other situations, it’s simply a question of aesthetics—some like it; others would prefer to live without it.

There’s a flip side to this issue as well. When teeth need to be replaced, many people opt to have their smile restored just the way it was, rather than in some “ideal” manner. That could mean that their dentures are specially fabricated with a space between the front teeth, or the crowns of their dental implants are spaced farther apart than they normally would be. For these folks, the “imperfection” is so much a part of their unique identity that changing it just seems wrong.

So if you’re satisfied with the way your smile looks, all you need to do is keep up with daily brushing and flossing, and come in for regular checkups and cleanings to keep it healthy and bright. If you’re unsatisfied, ask us how we could help make it better. And if you need tooth replacement, be sure to talk to us about all of your options—teeth that are regular and “Hollywood white;” teeth that are natural-looking, with minor variations in color and spacing; and teeth that look just like the smile you’ve always had.

Because when it comes to your smile, we couldn’t agree more with what Lonnie Chaviz said at the end of his video: “Be who you want to be. Do what you want to do. Do you. Be you. Believe in yourself.”

If you’ve noticed a small sore in your mouth, it’s possible you have a non-contagious disease known as lichen planus. Although usually benign, it’s still a good idea to have it examined and monitored.

The condition is so named because its lesions are similar in appearance to lichen, the algae and fungi organism often found on rocks and trees. It’s believed to be a type of autoimmune disease, in which the body treats some of its own cells as foreign and reacts adversely to them. Certain medications and substances may also cause a lichenoid reaction. Besides the inner cheeks, gums or tongue, lichen planus may also appear on other skin or mucous surfaces on the wrists, legs or fingernails.

When it appears inside the mouth it usually resembles a lacy pattern of white lines or ulceration. Gum tissues may become red and inflamed, with some soreness after brushing or eating. Although there’s no known cure for lichen planus, it rarely causes serious problems — in fact, you may not even be aware you have the condition unless pointed out during a dental exam. It may, in time, fade away.

If the lesions do become bothersome (painful, itchy or overly-sensitive), there are some ways to ease discomfort: brushing with a soft toothbrush (to minimize irritation), flossing, and avoiding acidic or spicy foods and beverages which have been known to cause flare-ups. Managing stress is also helpful, and a topical steroid may be prescribed for more severe outbreaks.

Perhaps the greatest concern with lichen planus, though, is it may resemble more serious conditions, particularly oral cancer. The only way to be certain that it is a benign condition is to perform a biopsy on some of the affected tissue. If you notice a problem, be sure to visit us for a complete examination. And regardless of whether you have the condition or not, regular oral cancer screenings, as well as limits on alcohol consumption and stopping use of tobacco, will also reduce your risk of oral cancer.

Odds are if you have a case of lichen planus it isn’t causing you any problems. If it does cause you discomfort, though, you can take steps to ease your symptoms.

It’s hard to avoid stress in the 21st Century. We’re all bombarded with stressors, from work to family — even our smart phones!

The problem really isn’t the stressors themselves but how we respond to them and try to relieve stress. This can often have a negative effect on our health. One example: bruxism, also known as teeth grinding or clenching.

These habits involve the rhythmic or spasmodic clenching, biting or grinding of the teeth, often involuntarily, beyond normal chewing function. It often occurs while we sleep — jaw soreness the next morning is a telltale sign. While there are other causes, stress is one of the most common for adults, bolstered by diet and lifestyle habits like tobacco or drug use, or excessive caffeine and alcohol.

Teeth grinding’s most serious consequence is the potential for dental problems. While teeth normally wear as we age, grinding or clenching habits can accelerate it. Wearing can become so extensive the enamel erodes, possibly leading to fractures or cracks in the tooth.

When dealing with this type of bruxism, we must address the root cause: your relationship to stress. For example, if you use tobacco, consider quitting the habit — not only for your overall health, but to remove it as a stress stimulant. The same goes for cutting back on your consumption of caffeinated or alcoholic drinks.

Adopt an “unwinding” pattern at night before you sleep to better relax: for example, take a warm bath or keep work items or digital media out of the bedroom.Â Many people also report relaxation or stress-relief techniques like meditation, mindfulness or biofeedback helpful.

There’s another useful tool for easing the effects of nighttime teeth grinding: an occlusal guard. This custom-fitted appliance worn while you sleep prevents teeth from making solid contact with each other when you clench them. This can greatly reduce the adverse effects on your teeth while you’re working on other stress coping techniques.

Teeth grinding or clenching can prove harmful over time. The sooner you address this issue with your dentist or physician, the less likely you’ll experience these unwanted consequences.

Implant-supported fixed bridges are growing in popularity because they offer superior support to traditional bridges or dentures. They can also improve bone health thanks to the affinity between bone cells and the implants' titanium posts.

Even so, you'll still need to stay alert to the threat of periodontal (gum) disease. This bacterial infection usually triggered by dental plaque could ultimately infect the underlying bone and cause it to deteriorate. As a result the implants could loosen and cause you to lose your bridgework.

To avoid this you'll need to be as diligent with removing plaque from around your implants as you would with natural teeth. The best means for doing this is to floss around each implant post between the bridgework and the natural gums.

This type of flossing is quite different than with natural teeth where you work the floss in between each tooth. With your bridgework you'll need to thread the floss between it and the gums with the help of a floss threader, a small handheld device with a loop on one end and a stiff flat edge on the other.

To use it you'll first pull off about 18" of dental floss and thread it through the loop. You'll then gently work the sharper end between the gums and bridge from the cheek side toward the tongue. Once through to the tongue side, you'll hold one end of the floss and pull the floss threader away with the other until the floss is now underneath the bridge.

You'll then loop each end of the floss around your fingers on each hand and work the floss up and down the sides of the nearest tooth or implant. You'll then release one hand from the floss and pull the floss out from beneath the bridge. Rethread it in the threader and move to the next section of the bridge and clean those implants.

You can also use other methods like specialized floss with stiffened ends for threading, an oral irrigator (or "water flosser") that emits a pressurized spray of water to loosen plaque, or an interproximal brush that can reach into narrow spaces. If you choose an interproximal brush, however, be sure it's not made with metal wire, which can scratch the implant and create microscopic crevices for plaque.

Use the method you and your dentist think best to keep your implants plaque-free. Doing so will help reduce your risk of a gum infection that could endanger your implant-supported bridgework.

Some people are lucky — they never seem to have a mishap, dental or otherwise. But for the rest of us, accidents just happen sometimes. Take actor Jamie Foxx, for example. A few years ago, he actually had a dentist intentionally chip one of his teeth so he could portray a homeless man more realistically. But recently, he got a chipped tooth in the more conventional way… well, conventional in Hollywood, anyway. It happened while he was shooting the movie Sleepless with co-star Michelle Monaghan.

“Yeah, we were doing a scene and somehow the action cue got thrown off or I wasn't looking,” he told an interviewer. “But boom! She comes down the pike. And I could tell because all this right here [my teeth] are fake. So as soon as that hit, I could taste the little chalkiness, but we kept rolling.” Ouch! So what's the best way to repair a chipped tooth? The answer it: it all depends…

For natural teeth that have only a small chip or minor crack, cosmetic bonding is a quick and relatively easy solution. In this procedure, a tooth-colored composite resin, made of a plastic matrix with inorganic glass fillers, is applied directly to the tooth's surface and then hardened or “cured” by a special light. Bonding offers a good color match, but isn't recommended if a large portion of the tooth structure is missing. It's also less permanent than other types of restoration, but may last up to 10 years.

When more of the tooth is missing, a crown or dental veneer may be a better answer. Veneers are super strong, wafer-thin coverings that are placed over the entire front surface of the tooth. They are made in a lab from a model of your teeth, and applied in a separate procedure that may involve removal of some natural tooth material. They can cover moderate chips or cracks, and even correct problems with tooth color or spacing.

A crown is the next step up: It's a replacement for the entire visible portion of the tooth, and may be needed when there's extensive damage. Like veneers, crowns (or caps) are made from models of your bite, and require more than one office visit to place; sometimes a root canal may also be needed to save the natural tooth. However, crowns are strong, natural looking, and can last many years.

But what about teeth like Jamie's, which have already been restored? That's a little more complicated than repairing a natural tooth. If the chip is small, it may be possible to smooth it off with standard dental tools. Sometimes, bonding material can be applied, but it may not bond as well with a restoration as it will with a natural tooth; plus, the repaired restoration may not last as long as it should. That's why, in many cases, we will advise that the entire restoration be replaced — it's often the most predictable and long-lasting solution.

Oh, and one more piece of advice: Get a custom-made mouthguard — and use it! This relatively inexpensive device, made in our office from a model of your own teeth, can save you from a serious mishap… whether you're doing Hollywood action scenes, playing sports or just riding a bike. It's the best way to protect your smile from whatever's coming at it!

While it doesn’t garner the star power of blood, saliva is still an important bodily fluid. A true multi-tasker, saliva contributes in many ways to the function and health of the body, from stronger teeth to more efficient digestion.

The mouth’s natural cleanser. Bacteria are responsible for much of the dental disease that plagues us, particularly tooth decay and gum disease. Saliva clears the mouth of food remnants, bacteria’s primary feeding source, after we eat. This leaves a cleaner mouth and fewer bacteria to cause infection.

The immune system’s partner. Saliva contains an antibody called Immunoglobulin A (IgA) that attacks disease-causing microorganisms. Along with secreting other antibacterial agents like lactoferrin and lyzozyme that curb the growth and development of bacteria, saliva serves as the body’s first line of defense against pathogens entering through the mouth.

Acid neutralizer. The optimal oral environment is a neutral pH of 7. Many of our foods and beverages, though, are highly acidic, which can raise the mouth’s acid level. The acidic environment causes the minerals in tooth enamel to soften and dissolve (a process called de-mineralization). Saliva restores the balance by neutralizing any remaining acid after we eat (a process that takes about 30 to 60 minutes).

Mineral replacer. Even under normal conditions, enamel will de-mineralize to some extent whenever the mouth becomes acidic. Saliva restores some of the enamel’s lost minerals like calcium and phosphate while it’s neutralizing acid. If fluoride is also present in saliva from fluoridated drinking water or toothpaste, it too is absorbed by the enamel making it stronger and more resistant to acid attacks.

Digestion enhancer. Saliva lubricates the mouth while we eat, making it easier for us to chew (and taste) our food. Saliva also releases the enzyme amylase as we chew to break down starches before the food enters our stomach. The end result is more efficient and comfortable digestion.

The wave of the future in diagnostics. Like blood and urine, saliva contains genetic and disease markers that could tell a physician if a patient has a certain condition. Since collecting a saliva sample is much easier than with these other bodily fluids, diagnosing disease with saliva will become more prevalent as more calibrated devices reach the market.

If you would like more information on the role of saliva in the body, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Saliva.”

Around 20 million people—mostly women after menopause—take medication to slow the progress of osteoporosis, a debilitating disease that weakens bones. But although effective, some osteoporosis drugs could pose dental issues related to the jawbones.

Osteoporosis causes the natural spaces that lie between the mineral content of bone to grow larger over time. This makes the bone weaker and unable to withstand forces it once could, which significantly increases the risk of fracture. A number of drugs have been developed over time that stop or slow this disease process.

Two of the most prominent osteoporosis drugs are alendronate, known also by its trade name Fosamax, and denosumab or Prolia. While originating from different drug families, alendronate and denosumab work in a similar way by destroying specialized bone cells called osteoclasts that break down worn out bone and help dissolve it. By reducing the number of these cells, more of the older bone that would have been phased out lasts longer.

In actuality this only offers a short-term benefit in controlling osteoporosis. The older bone isn’t renewed but only preserved, and will eventually become fragile and more prone to fracture. After several years the tide turns negatively for the bone’s overall health. It’s also possible, although rare, that the bone simply dies in a condition called osteonecrosis.

The jawbones are especially susceptible to osteonecrosis. Forces generated by chewing normally help stimulate jawbone growth, but the medications in question can inhibit that stimulus. As a result the jawbone can diminish and weaken, making eventual tooth loss a real possibility.

Osteonecrosis is most often triggered by trauma or invasive dental procedures like tooth extractions or oral surgery. For this reason if you’re taking either alendronate and denosumab and are about to undergo a dental procedure other than routine cleaning, filling or crown-work, you should speak to your physician about suspending your medication temporarily. Dentists often recommend a suspension of three to nine months before the procedure and three months afterward.

Some research indicates this won’t worsen your osteoporosis symptoms, especially if you substitute another treatment or fortify your skeletal system with calcium and vitamin D supplements. But taking this temporary measure could help protect your teeth in the long run.

Porcelain crowns have been used to restore problem teeth since at least the early 20th Century. Crown technology has gradually progressed from the early use of precious metals like gold or silver to more life-like porcelain crowns, often with a metal interior for added strength. Today, most crowns are all-porcelain, made with newer materials that not only look attractive but can endure under the pressures of daily chewing or biting.

While crowns are often part of restorations for missing teeth, they’re also commonly used to cap or fit over a viable tooth with structural or appearance problems. Here are 4 situations where a crown could improve a tooth’s form and function.

Traumatized teeth. A significant blow to the face or mouth could generate enough force to chip away or fracture a significant amount of structure from a tooth. If the root remains healthy and firmly attached within the jaw, however, a crown can replace the missing structure and restore the tooth’s function and appearance.

Root canal treatments. Root canal treatments remove infected or dead tissue within a tooth’s pulp chamber, its inner core, and the root canals. The procedure rescues the tooth but can in the process significantly alter the tooth’s structure and appearance. A crown not only restores the tooth but also provides added protection against further decay or tooth fracture.

Teeth with multiple fillings. We can effectively treat cavities caused by tooth decay by filling them. But with each filling we must remove more of the decayed structure and shape the cavity to accommodate the filling. After a number of times, a tooth may not have enough structure left to support another filling. If the tooth is still viable, a crown could solve this dilemma.

Abnormally developed teeth. Teeth sometimes don’t erupt in the jaw as they should and may be only partly visible. The tooth not only looks out of place but it can’t fully function like a normal tooth. Capping an abnormally developed tooth with a crown will help normalize it and allow it to blend in with surrounding teeth.

Mayim Bialik has spent a good part of her life in front of TV cameras: first as the child star of the hit comedy series Blossom, and more recently as Sheldon Cooper’s love interest — a nerdy neuroscientist — on The Big Bang Theory. (In between, she actually earned a PhD in neuroscience from UCLA…but that’s another story.) As a child, Bialik had a serious overbite — but with all her time on camera, braces were just not an option.

“I never had braces,” she recently told Dear Doctor – Dentistry & Oral Health magazine. “I was on TV at the time, and there weren’t a lot of creative solutions for kids who were on TV.” Instead, her orthodontist managed to straighten her teeth using retainers and headgear worn only at night.

Today, there are several virtually invisible options available to fix orthodontic issues — and you don’t have to be a child star to take advantage of them. In fact, both children and adults can benefit from these unobtrusive appliances.

Tooth colored braces are just like traditional metal braces, with one big difference: The brackets attached to teeth are made from a ceramic material that blends in with the natural color of teeth. All that’s visible is the thin archwire that runs horizontally across the teeth — and from a distance it’s hard to notice. Celebs like Tom Cruise and Faith Hill opted for this type of appliance.

Clear aligners are custom-made plastic trays that fit over the teeth. Each one, worn for about two weeks, moves the teeth just a bit; after several months, you’ll see a big change for the better in your smile. Best of all, clear aligners are virtually impossible to notice while you’re wearing them — which you’ll need to do for 22 hours each day. But you can remove them to eat, or for special occasions. Zac Efron and Katherine Heigl, among others, chose to wear clear aligners.

Lingual braces really are invisible. That’s because they go behind your teeth (on the tongue side), where they can’t be seen; otherwise they are similar to traditional metal braces. Lingual braces are placed on teeth differently, and wearing them often takes some getting used to at first. But those trade-offs are worth it for plenty of people. Which celebs wore lingual braces? Rumor has it that the list includes some top models, a well-known pop singer, and at least one British royal.

So what’s the best way to straighten your teeth and keep the orthodontic appliances unnoticeable? Just ask us! We’d be happy to help you choose the option that’s just right for you. You’ll get an individualized evaluation, a solution that fits your lifestyle — and a great-looking smile!

Chronic pain can turn your life upside down. While there are a number of disorders that fit in this category, two of them—fibromyalgia and temporomandibular disorders (TMD)—can disrupt your quality of life to the extreme. And it may be the two conditions have more in common than similar symptoms—according to one study, three-fourths of patients diagnosed with fibromyalgia show symptoms of TMD.

To understand why this is, let’s take a closer look at these two conditions.

Fibromyalgia presents as widespread pain, aching or stiffness in the muscles and joints. Patients may also have general fatigue, sleep problems, mood swings or memory failures. TMD is a group of conditions that often result in pain and impairment of the temporomandibular joints that join the jaw with the skull. TMD can make normal activities like chewing, speaking or even yawning painful and difficult to do.

Researchers are now focusing on what may, if anything, connect these two conditions. Fibromyalgia is now believed to be an impairment of the central nervous system within the brain rather than a problem with individual nerves. One theory holds that the body has imbalances in its neurotransmitters, which interfere with the brain’s pain processing.

Researchers have also found fibromyalgia patients with TMD have an increased sensitivity overall than those without the conditions. In the end, it may be influenced by genetics as more women than men are prone to have either of the conditions.

Treating these conditions is a matter of management. Although invasive techniques like jaw surgery for TMD are possible, the results (which are permanent) have been inconclusive in their effectiveness for relieving pain. We usually recommend patients try more conservative means first to lessen pain and difficulties, including soft foods, physical therapy, stretching exercises and muscle relaxant medication. Since stress is a major factor in both conditions, learning and practicing relaxation techniques may also be beneficial.

In similar ways, these techniques plus medication or cognitive-behavioral therapy that may influence neurotransmission can also help relieve symptoms of fibromyalgia. Be sure then that you consult with both your physician and dentist caring for both these diseases for the right approach for you to help relieve the effects of these two debilitating conditions.